You know, I was lying in bed this morning thinking about Ralph and the big nasty foul barf he did (...as you do... ) and I had a bit of an "Aha" moment. In Ayurvedic medicine (traditional Indian/Yogic), emesis is a recognised treatment and is often used to induce a cleanse. Animals naturally and instinctively do this, often stimulating it by grass-eating etc. It occurred to me that this might have been the major cleanse he knew he had to have, as from your description it came from a very deep place, I would think.

Does this make sense or are you inclined to think I'm mystic-babbling?